老年大肠癌临床病理特点分析

目的探索老年大肠癌的临床病理特点。方法对１１７例老年人大肠癌的病理资料进行回顾性分析，并与对照组进行比较。结果老年组大肠癌占老年大肠肿瘤的５５．４５％，高于对照组（Ｐ＜０．０５），其中绒毛状腺癌明显高于对照组（Ｐ＜０．０１），而粘液腺癌和粘液细胞癌则明显低于对照组（Ｐ均＜０．０５）。老年大肠癌的浸润深度明显浅于对照组（Ｐ＜０．０５），而其转移率则与对照组无明显差别。老年大肠癌的好发部位与其他年龄有所不同，依次为直肠、乙状结肠、回盲部、降结肠、肝曲、升结肠、横结肠和脾曲。结论老年大肠癌发病率高于其他年龄，老年大肠癌的组织类型与其他年龄有所不同，且老年大肠癌的局部侵袭力低于其他年龄。老年大肠癌发生部位与其他年龄有所不同     

早期大肠癌的临床病理特点

目的 总结早期大肠癌的临床病理组织学特点,探讨不同临床特点的早期大肠癌的治疗方法。方法 对16年间经内镜发现并术后病理证实的早期大肠癌105例106个病变,进行临床病理学分析。结果 早期大肠癌中91.5%的病变位于乙状结肠以下。内镜下的肉眼形态分别为：Ip型34个,Ips型13个,Is型26个,IIa型11个,IIa IIc型22个。其中IIa IIc型的22个病变中21个为粘膜下的癌(Sm）。Sm癌的25个病变中出现3例（12%）淋巴结转移。治疗上,经内镜下切除13个病变（12例）,其中1例Sm癌术后局部复发,行根治性手术。单纯局部切除术或者肠管切除术加淋巴结清扫术93个病发。结论 IIa IIc型的大部分为Sm癌;低、中分化腺癌中以Sm癌我见;淋巴结转移仅出现在Sm癌中,凡出现上述情况之一的,均应行根治性手术。     

高龄大肠癌92例临床病理分析

随着社会向高龄化的发展，高龄大肠癌发病率在我国亦有逐年增加趋向。为探讨高龄大肠癌的临床病理学特征，作者对本院收治７０岁以上的大肠癌患者的临床及其病理学特征进行统计分析。１．临床资料：均为本院近２０年收治的７０岁以上进展期大肠癌，共９２例，占同期大肠癌病例的８．３％（９２／１１１２）。男５８例，女３４例。男：女为１．７：l。病程１个月至５年不等，平均６．８个月。首发症状以血便、排便习惯改变为主者７４例，完全性肠梗阻急诊就医者５例，不完全性肠梗阻、腹痛及排便困难者１３例。肿瘤位于肛管２例，直肠７２例…     

胰腺囊腺癌临床病理特征分析

胰腺囊腺癌临床较为少见,约占胰腺癌总体的5％～10％[1]。研究认为,胰腺囊腺癌恶性程度相对较低,肿瘤常有纤维包膜,手术切除率较高,预后较好。近年国外报道的囊腺癌术后5年生存率已达63％[2]。本文对52例胰腺囊腺癌患者的临床资料进行分析,试图找出胰腺囊腺癌的若干特点。     

青年人大肠癌临床、内镜、病理特点分析

青年人(≤35岁)大肠癌在临床、病理、预后等方面与中老年患者比较有不同的特点。本文报告我院67例青年人大肠癌，将其临床、内镜、病理特点与中老年患者作对比分析，以提高对青年人大肠癌的认识和早期诊断能力。     

186例大肠癌分析

大肠癌是常见恶性肿瘤之一,近年来年轻人发病率逐渐增加,本院从 1994年 7月～ 19 98年 4月肠镜检查 2 307例,经病理、手术证实 186例大肠癌,检出率为 8.1％,现报告如 下。 临床资料：本组病例男 103例,女 83例,男：女为 1.24： 1,年龄 19～ 81岁,平均 55.8岁,其中 60岁以上 80例, 30～ 40岁 22例, 30岁以下 8例,病程 1个月～ 2年, 平均 12.5个月。临床主要表现为粘液血便、排便习惯改变、腹痛、里急后重、腹部包块、 贫血及恶病质,易误诊为痔疮、肛裂、慢性结肠炎、痢疾及息肉。 结果：大肠癌可发生于各个肠段,尤以直肠最多…     

大肠癌患者的临床、病理及预后分析576例

目的:分析不同年龄组大肠癌患者的临床特点并探讨影响大肠癌预后的因素.方法:对近5a我院576例大肠癌患者进行回顾性分析,比较不同年龄组大肠癌患者的临床、病理及预后资料.结果:不同年龄组之间各部位大肠癌发生率无显著性差异.腹痛在青年组中发生频率显著高于中年组和老年组(x~2=7.20,P<0.05);消瘦在老年组中发生频率显著高于青年组和中年组(x~2=9.64,P<0.05).与中年组和老年组相比青年组黏液腺癌发生率高(x~2=43.71,P<0.05),老年组高分化癌发生率高(x~2=8.06,P<0.05).青年组淋巴结转移率较老年组高(x~2=4.47,P<0.05).总体5a生存率为61.79%±5.48%;青年组、中年组、老年组5a生存率分别为43.64%±21.24%.87.16%±5.44%和53.79%±6.69%,3组间差异显著(P<0.05).影响大肠癌患者预后的因素有年龄、肿瘤细胞分化程度、有无淋巴结转移、Dukes分期、是否根治性手术.结论:青年大肠癌患者腹痛多见,恶性程度高,淋巴结转移常见,预后差.老年患者消瘦多见,癌肿分化好,预后较好.影响大肠癌患者预后的独立因素有年龄、Dukes分期等.     

原发性胃肠道淋巴瘤临床病理特征分析14例

目的:探讨原发性胃肠道淋巴瘤(PGIL)的临床、病理特点、疾病分期、内镜及影像学表现以提高诊治水平.方法:回顾性分析我院1994-01/2008-03经内镜活检或手术病理证实的14例PGIL患者的临床资料.结果:14例PGIL中原发于胃8例, 肠道5例, 1例为混合部位. 临床症状依次为腹痛(92.86%)、消瘦(35.71%)、纳差(28.57%)及腹部包块与贫血(21.42%). 病理类型低度恶性淋巴瘤2例(14.29%), 高度恶性淋巴瘤12例(其中DLBL2例, 伴有MALT成分的DLBL10例). 9例患者临床分期为Ⅰ期, 3例为ⅡE, 2例为Ⅲ期. PIL及混合部位组较PGL组年龄小, 二组之间比较差异有显著性(49.00±13.05 vs 69.12±7.7, P<0.01).结论:PGIL临床症状无特异性, 病理类型以高度恶性淋巴瘤常见, PIL及混合部位淋巴瘤发病年龄小且分期晚, 值得临床高度重视.     

直径≤10 mm进展期大肠癌的内镜和临床病理特点

目的：研究直径≤10mm进展期大肠癌的内镜和临床病理特点。方法：总结12例直径≤10mm进展期大肠癌的临床资料，并与直径＞10mm进展期大肠癌的直镜下特点和临床病理作比较。结果：直径≤10mm进展期大肠癌肉眼似Ⅱc 5例，似Ⅱa 3例，似Is 4例。病灶直径6－10mm，侵犯至肌层8例，侵犯至浆膜层4例。内镜下均有黏膜皱襞集中和表面略有凹陷，以及Vs型的腺管开口型的特点。无一例分布在直肠。淋巴结转移率为33％。结论：直径≤10mm进展期大肠癌可能由表面平坦凹陷型发展而来。此类病灶可以通过黏膜皱襞改变和腺管开口类型来进行辨别。     

大肠癌1561例临床病理分析

目的了解南昌地区大肠癌的临床病理特点及近年来的变化趋势。方法回顾性调查南昌大学第一附属医院内镜中心1990年1月至2004年12月15年间行结肠镜检查并经病理证实为大肠癌的患者，分析临床病理特点及其变化趋势。结果15年来共行结肠镜检21853例，确诊的大肠癌共1561例，检出率为7．10，平均发病年龄52岁，男女比例为1．4：1。直肠是大肠癌的最常见部位，占43．4％；左半结肠癌多于右半结肠癌（30．5％比26．1％，P〈0．05）；〈30岁的患者直肠癌比例最高（57．5％），随年龄增加，乙状结肠及左半结肠癌构成比增多，而直肠癌减少。高、中分化腺癌是大肠癌的主要病理类型，占83．6％；黏液癌女性多于男性，其他病理类型男性多见。随年龄增加，高中分化的大肠癌增多，低分化腺癌、印戒细胞癌减少。比较每5年大肠癌的临床病理特点发现，自1990至1999年大肠癌的标化检出率呈上升趋势，但近5年呈下降趋势；直肠癌构成比增加，左半结肠癌构成比减少；高、中分化型大肠癌增加（80．0％增至85．6％，P〈0．05），低分化腺癌减少（13．9％降至8．8％，P〈0．05）。结论南昌地区大肠癌检出率较低，其中直肠癌检出率较低；随年龄增加，左半结肠癌增多。近年来，大肠癌的检出率减少，直肠癌增加，左半结肠癌减少；高中分化型大肠癌增加，低分化腺癌减少。     

性别与结直肠癌发病特点关系的分析

[目的]分析性别与结直肠癌临床特点的关系.[方法]收集2001-10-2011-10期间在华北地区6家医院检出结直肠癌患者资料,分析性别与发病年龄、肿瘤发生部位、腺癌分化程度的关系.[结果]2450例结直肠癌患者中男性1377例,女性1073例.男∶女为1.28∶1.00;女性发病率升高.右半结肠癌比例升高.性别与结直肠癌发生年龄、发生部位、腺癌分化程度均无明显的相关性(P＞0.05).[结论]结直肠癌发病率呈上升趋势,女性大肠癌患者比例有增加趋势.筛查是结直肠癌早诊早治的关键,筛查的起始年龄应按筛查目标确定.结直肠癌发病部位应重视右半结肠发病率升高现象,全结肠镜检查为首选.     

Clinical and molecular features of young-onset colorectal cancer

Colorectal cancer(CRC) is one of the leading causes of cancer related mortality worldwide. Although young-onset CRC raises the possibility of a hereditary component, hereditary CRC syndromes only explain a minority of young-onset CRC cases. There is evidence to suggest that young-onset CRC have a different molecular profile than late-onset CRC. While the pathogenesis of young-onset CRC is well characterized in individuals with an inherited CRC syndrome, knowledge regarding the molecular features of sporadic young-onset CRC is limited. Understanding the molecular mechanisms of young-onset CRC can help us tailor specific screening and management strategies. While the incidence of late-onset CRC has been decreasing, mainly attributed to an increase in CRC screening, the incidence of young-onset CRC is increasing. Differences in the molecular biology of these tumors and low suspicion of CRC in young symptomatic individuals, may be possible explanations. Currently there is no evidence that supports that screening of average risk individuals less than 50 years of age will translate into early detection or increased survival. However, increasing understanding of the underlying molecular mechanisms of young-onset CRC could help us tailor specific screening and management strategies. The purpose of this review is to evaluate the current knowledge about young-onset CRC, its clinicopathologic features, and the newly recognized molecular alterations involved in tumor progression.     

Clinicopathologic and immunohistochemical study of early colorectal cancer with liver metastases

Seven (3.3%) of 213 patients who underwent surgery for early colorectal cancer (invasion limited to no deeper than the submucosa) at the National Cancer Center Hospital, Tokyo, between 1986 and 1995 had synchronous (2 patients) or metachronous (5 patients) liver metastases. The average period from surgical resection of the primary colorectal cancer to the diagnosis of liver metastases was 25 months (range, 0–52 months). The clinicopathologic and immunohistochemical features of the primary lesions in these patients were compared with these features in the lesions in consecutive patients with early colorectal cancer who had no evidence of liver metastases within at least 5 years after colorectal resection. Venous invasion was more frequent in the primary lesions with liver metastases than in those without liver metastases (57% vs 0%; P = 0.0035). Expression of p53 and CD44v9 was more frequent in the primary lesions with liver metastases (71% and 100%) than in those without metastases (56% and 72%). In contrast, MUC2 expression was more frequent in the primary lesions without liver metastases (72%) than in those with metastases (43%). Venous invasion is considered to be closely related to liver metastasis, and the immunohistochemical expression of p53 and CD44v9 provides useful information for identifying those patients with early colorectal cancer who have a high risk of developing liver metastases. Received: June 16, 1998/Accepted: October 23, 1998     

Gastrin and colorectal cancer

Plasma gastrin has been reported to be elevated among patients with colorectal cancer. The objectives of the present study were to confirm this observation and, if confirmed, to shed light on the reason for the elevation. Presurgical and postsurgical fasting plasma gastrin levels were compared between 24 patients hospitalized for colorectal adenocarcinoma resection and 25 control patients hospitalized for other surgery. Elevated presurgical gastrin levels in the case group that fell after surgery woulds be consistent with preduction of gastrin by the tumor. High presurgical gastrin levels in the case group that did not change following surgery would be consistent with excess gastrin production by G cells. The mean presurgical gastrin levels were 21.9±3.7 pM (cases) and 45.1±18.0pM (controls). The mean postsurgical gastrin levels were 20.5±3.9 pM (cases) and 43.4±14.6 pM (control). These results do not provide support for the hypothese that gastrin is elevated in colorectal cancer patients or that gastrin is secreted by colorectal tumors in sufficient quantities to be measurable in the plasma.This work was supported by the National Cancer Institute (P01-CA42101, Cancer Prevention Research Unit for Connecticut at Yale University). Dr. Yapp was supported by a Training Grant (DK 07017) awarded by the National Institute of Diabetes, Digestive and Kidney Diseases. Dr. Dubrow received support from a National Cancer Institut Preventive Oncology Academic Award (K07-CA01463).     

Clinicopathologic studies of immunologic fecal occult blood test for colorectal cancer

In our hospital, 83 patients with colorectal cancer underwent the immunologic fecal occult blood test (IFOBT). The positive rate for IFOBT in all patients was 87%. Colon cancers more proximal than the transverse colon were 100% positive. Carcinomas of the ulcerative type showed a significantly higher positive rate than those of the non-ulcerative type (94% vs 73%). Carcinomas penetrating the muscularis or beyond showed a significantly higher positive rate, of 96% (52/54 cases) compared to carcinomas confined to the mucosa or submucosa, which gave positive rates of 64% and 60%, respectively. In the investigation of the 7 patients with colorectal cancer who showed negative results on the IFOBT, IFOBT had been performed only once in of these patients. Accordingly, it was considered necessary to perform IFOBT more than once. The cancers in 5 of these 7 patients were found to be carcinomas confined to the mucosa. This result suggests the advisability of annual IFOBTs. It is also considered necessary to manage patients who show undefinable but possibly positive (±) results with caution.     

Clinical and molecular analysis of hereditary non-polyposis colorectal cancer in Chinese colorectal cancer patients

AIM:To analyze the frequency of hereditary non-polyposis colorectal cancer(HNPCC)in Chinese colorectal cancer(CRC)patients,and to discuss the value of microsatellite instability(MSI)and/or immunohistochemistry(IHC)for MSH2/MLH1 protein analysis as pre-screening tests in China.METHODS:The Amsterdam criteriaⅠandⅡ(clinical diagnosis)and/or germline hMLH1/hMSH2 mutations(genetic diagnosis)were used to classify HNPCC families.Genetic tests,including microsatellite instability,immunohistochemistry for MSH2/MLH1 proteins and hMSH2/hMLH1 genes,were performed in each proband.RESULTS:From July 2000 to June 2004,1988 patients with colorectal cancer were analysed and 114 CRC patients(5.7%)from 48 families were categorized as having HNPCC,including 76 from 26 families diagnosed clinically and 38 from the other 22 families diagnosed genetically.The sensitivity and specificity of high MSI and IHC for predicting mutations were 100% and 54%,and 79% and 77%,respectively.CONCLUSION:The frequency of HNPCC is approximately 10% among all Chinese CRC cases.The MSI and IHC detections for hMSH2/hMLH1 proteins are reliable pre-screening tests for hMLH1/hMSH2 germline mutations in families suspected of having HNPCC.     

Diagnosis of depth of invasion for early colorectal cancer using magnifying colonoscopy

Background and Aims: Early colorectal cancer (CRC) with submucosal deep (s.m.‐d.) invasion should not be treated with endoscopic mucosal resection due to the higher incidence of lymph‐node metastasis. It is, therefore, clinically important to accurately diagnose s.m.‐d. lesions before treatment. Methods: We analyzed the endoscopic features, including pit patterns, of early CRC with s.m.‐d. invasion observed using magnifying colonoscopy. We retrospectively investigated 379 cases of early CRC. Lesions were divided into three macroscopic subtypes (pedunculated type, sessile type and superficial type) based on endoscopic findings. Eight endoscopic factors were evaluated retrospectively for association with s.m. invasion and then compared to histopathological findings. Results: The superficial type had a significantly higher frequency of s.m.‐d. invasion (52.4% [77/147] vs 24.6% [14/57] and 39.4% [69/175], P‐value < 0.05, respectively, for pedunculated and sessile types). Based on multivariate analysis, an independent risk factor for s.m.‐d. invasion was the existence of an invasive pit pattern in sessile and superficial types (odds ratios of 52.74 and 209.67, respectively). Fullness was also an independent risk factor for s.m.‐d. invasion in the superficial type (odds ratio = 9.25). There were no independent risk factors for s.m.‐d. invasion in the pedunculated type. Conclusion: High magnification pit pattern diagnosis proved to be useful for predicting s.m.‐d. invasion in sessile and superficial types although it was not as helpful with the pedunculated type.     

遗传性非息肉病性大肠癌6家系临床分析

目的总结遗传性非息肉病性大肠癌(HNPCC)的临床特征,提高其早期诊断和治疗水平。方法对我院6个HNPCC家系进行调查,记录患者性别、发病年龄、肿瘤部位等。结果6个家系有大肠癌患者19例,占同期所有大肠癌的2.7%。其中男性10例,女性9例;发病年龄为26～74岁,中位年龄为53.4岁;共有大肠癌病灶23处,60.9%位于右半结肠,多原发大肠癌有4例。另有大肠腺瘤患者2例,白血病患者1例,原发性肝癌患者1例。结论HNPCC有明显的临床特征,利用这些特征有助于早期诊断和提高防治效果。     

Influence of cancer-related gene polymorphisms on clinicopathological features in colorectal cancer

Background and Aim:  Single nucleotide polymorphisms (SNP) are shown to be related with cancer incidence. It has been reported that CCND1 , p21 ^cip1 DCC , MTHFR, and EXO1 are related with the risk of malignant neoplasm, but few studies have mentioned the prognosis of the patients. We investigated the SNP of patients and related this to clinicopathological features, including survival rate.
Method:  DNA from the tissues of primary colorectal cancer was obtained from surgical resections of 114 patients (68 males and 46 females, 29–83 years). The CCND1 polymorphism was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and those of other genes were investigated by the TaqMan method. The polymorphisms obtained were statistically analyzed for the relationship with clinicopathological features.
Results:  The CG  +  GG allele was more invasive than the CC allele in histological tumor depth in the DCC codon 201 ( P  = 0.0086). The 677TT allele in MTHFR had a larger tumor size than the 677CC allele ( P  = 0.028). In EXO1 P757L polymorphism, patients with the TT allele had a statistically reduced survival rate compared with the other alleles. In CCND1 polymorphisms, we found no statistical significance in clinicopathological features.
Conclusions:  From these preliminary data, these polymorphisms would be candidates predicting the clinicopathological features of colorectal cancer, but further more systematic gene analyses are warranted.